Hypertension Flashcards
Hypertension definition
Elevation of systemic BP above a value deemed to carry excessively high risk of hypertension complications
BP =
CO x PRV
pressure of blood in an artery
influenced by genetic and environmental factors
Treating HTN lowers the risk for
stroke
MI
CHF
Detrimental issues leading to HTN
Obesity Sedentary lifestyle Sodium in diet Excessive water Alcohol Caffeine
Cigarettes NSAIDS Recreational drugs Decongestants Herbal supplements
Goals of HTN Therapy
Get BP <150
Resistant HTN
> /= 140/90 despite 3 drugs
30% of pts need 3 or more drugs
< 30% of pts achieve goal with 1 drug
Pathology of systemic HTN
Complications
Intimal arterial thickening and atherosclerosis
Many findings on exam of pt related to complications
- LV enlargement
- Hypertensive nephrosclerosis
- Intracranial bleeding
- Thromboembolic episodes
- Disease of the retina
Normal HTN
< 120/80
Prehypertension
120-139 / 80-89
Stage 1 HTN
140-159 / 90-99
Stage 2 HTN
> 160 / or > 100
Malignant HTN
over 200/130 in presence of retinal abnormalities and often acute vascular damage
First diagnoses of HTN
s
Presentation of pts with HTN
-what is the most common complaint?
Most common: no complaints
Can have
- morning headaches
- less often changes in vision
- palpitations or chest discomfort
- fatigue or shortness of breath with exertion
What is the most common secondary cause of HTN?
What are some others?
CKD (chronic kidney disease)
-renal parenchyma disease leading to sodium and volume retention
others
- hyperaldosteronism
- renal artery stenosis
- pheochromocytoma
- coarctation of the aorta
- hyperthyroidism
- hyperparathyroidism
- Cushing’s syndrome
What are some clues of secondary HTN in P/E
- Prolonged abdominal bruit - renal artery stenosis
- Decreased or diminished femoral pulses - coarctation
- Renal calculi - hyperparathyroidism
- Hyperthyroidism symptoms
- Abdominal striae - Cushing’s
- Paroxismal H/A, pallor, palpitation - pheochromocytoma
Role of the kidney in primary HTN
normally: kidney secretes renin –> ATII –> inc BP
Most pts with HTN do not have high renin levels
Renin levels are often inappropriately normal (not suppressed)
Note: HTN follows the kidney if transplanted
BP = CO x PVR
which value is elevated in primary HTN?
CO normal
PVR elevated
Renin normal
Basic lab tests in HTNive patients
U/A Electrolytes BUN/creatinine FBS Lipids ECG
Special lab tests in HTNive patients
Aldosterone levels TSH Renin Renal artery doppler/CT or MRI Dexamethasone suppression test 24-hr catecholamines in pheo suspected
What is the most effect non-pharmacologic therapy for HTN?
weight loss
DASH diet
Dietary Approaches to Stop HTN
Rich in fruits and vegetables Low in fats Low sodium Reduce alcohol Exercise 30 minutes most days of the week
What drugs are preferred for pts with diabetes and mild to moderate kidney disease?
ACE inhibitors
What drugs are used in CHF?
ACE inhibitors and diuretics
Beta blockers should be avoided in?
pts with bronchospastic disease
blacks (do better with CCBs and diuretics)
younger pts
diabetics on insulin
Short acting CCBs have increased risk of ..
hypotension and MI
What type of drugs should be tried first with HTN?
diuretics
